BENEFIT UPDATE
1. As a retiree, if you elected to cancel your healthcare coverage prior, you will have
the opportunity to re-enroll at the new premium levels during any one annual
enrollment period. The next enrollment will be in November, 2005.
RETIREES MAY ADD ELIGIBLE DEPENDENTS INCLUDING NEW SPOUSES.
2. Benefits no longer provides for a $5.00 payment for the collection of a pap smear
during an office call, but will continue to cover payment for the analysis of the pap
test. In 2006, preventative care for women (also known as well woman) would
offer under your physicians guidance annual breast exams, pelvic exams and
pap smears. Routine screening mammograms for those age 40 and above
will now be covered once per calendar year.
3. SPOUSAL SURCHARGE PROVISION – In order to align the rollout of the spousal
surcharge among Caterpillar healthcare plans, we have to be informed that it will not
apply until
4. Full time student
requirements – Effective
dependents, age 19 and above, must be full-time students to maintain eligibility
for coverage.
The charts in this article will also be available on our website – www.uawlocal974.org
RETIREE AND ACTIVE EMPLOYEE
HEALTH CARE PLAN FOR 2006
By David E. Durbin
Printed below is a health care plan summary detailing premium, deductible, and co-pay obligations for both retirees and active employees. This should allow you to calculate your required out-of-pocket health care costs for 2006 as well as gain an understanding of how a major medical expense will impact yourself or your dependents. There are basically four categories of out-of-pocket expenses which you need to be aware of:
1) Monthly Premium Costs. This is the basic monthly charge that you will incur for having health care coverage. For retirees, the premium is determined by whether you are insured as an individual or a family and by whether you are
Medicare eligible. For active employees, the premium amount is determined
simply by
the number of people insured.
2) Deductibles. All deductibles for plan year 2006 will be $300.00 for individuals and $600.00 for families. Both active and retired employees will incur, out-of-pocket, the first $300.00 toward major medical expenses. If you are insuring dependents, you will also be personally responsible for an additional $300.00, if those dependents use the plan. Once you have paid your $300.00 out-of-pocket or your spouse and or dependents combined have reached $300.00 your yearly deductibles are satisfied.
3) Co-Insurance. All co-insurance obligations for plan year 2006 are scheduled on a 90%/10% basis. The insurance covers 90% of major medical expenses and you are responsible for the remaining 10%. This continues until you have reached your maximum out-of-pocket exposure.
4) Maximum
Out-of-Pocket Expenses. For
retirees, your date of retirement effects your maximum out-of-pocket
obligation. If you have retired between
Individuals and
$1,500.00 for families. If you retire between
Example: You go in the hospital for open heart surgery and incur $200,000.00 in medical bills. What will your maximum exposure be?
a. Retired
between
$750.00 ($300.00 deductible as well as an additional $450.00 at a
90%/10% split until you max out at the $750.00 level).
b. Retired
deductible as well as an additional $700.00 at a 90%/10% split until
you max out at the $1,000.00 level).
c. Active employee. Answer:
Same as employee retiring
or later.
Once the maximum out-of-pocket expense levels are met, you enjoy 100% coverage for the remainder of plan year 2006.